Europe in the CME News You have been reading about the major European financial crisis for weeks. Now you can learn the latest about minor crises in the European CME world: the new tax in France, the leadership shakeup at UEMS, and tighter rules for EACCME accreditation. We wish you all the best for a happy holiday season and a prosperous 2012! -- Dennis, Lew and Barbara

France adopted mandatory continuing education for all physicians more than 15 years ago, but has never implemented the law. Now the French parliament has passed a new law regarding CME/CPD: an increased tax -- amounting to some 150 million euro -- on the overall income of pharmaceutical companies, the proceeds to be allocated to support CME/CPD.

The Assembly first voted for increasing the industry tax from 1% to 1.6%, and weeks later, the Senate supported the bill. It now goes to a commission to work out the final details. The implementing body will be the Organisme de Gestion Conventionnelle (OGC) now a not-for-profit body that collects funds from the Assurance Maladie Sécurité Sociale (70 million euro annually) and allocates these to medical associations proposing CME events for physicians in private practice, mostly GPs.

Under the new law, the OGC will become a public body, re-named OGDPC (Organisme de Gestion du Développement Professionnel Continu), collecting not only the social security funds but also the additional industry tax. These will then be allocated by OGDPC to medical associations and hospitals for CME events. Just how the 220 million euro is to be distributed is yet to be determined.

The medical unions supported the new law, not surprisingly, and are likely to influence the distribution process. Industry is less happy, and expectations are that companies will reduce the funds they currently use to support CME/CPD activities. Will the new method of funding reduce any perception of bias in topic or faculty selection or will the concern shift to the role of government or medical union influence? Finally, will France ever implement mandatory CME? We await the future with a mix of trepidation and excitement.

There were surprising results when, at its October meeting, the European Union of Medical Specialists (UEMS) chose new leaders. Edwin Borman MB, a Birmingham UK anesthesiologist (and a WentzMiller associate), was elected as secretary general, replacing Bernard Maillet MD, who had held that position for many years. Dr. Borman's opponent was Giorgio Berchicci MD, who had been the UEMS treasurer. Dr. Borman has drafted UEMS position papers on CME/CPD as well as rules for accrediting online CME through the European Accreditation Council for CME (EACCME), an arm of UEMS.

Dr. Maillet had decided to run for the presidency. But unexpectedly, Dr. Maillet lost the race, and Dr. Romauld Krajewski, a Polish neurosurgeon was elected president. So the leadership underwent a complete change.

At the same meeting, new guidelines for the accreditation of live CME were presented, as well as at a November 18 CME/CPD conference of UEMS. At the latter, new guidelines for e-learning CME were included. A key element of the e-learning guidelines now requires some measure of outcomes for each approved activity -- a requirement that is lacking in the guidelines for live events. Explains Dr. Borman: "By virtue of the prospective nature of accreditation processes and lack of availability of actual content, it is not possible to consider actual outcomes for live CME. Instead we have to work with proxy markers that we hope will be predictive of good educational outcomes." He added that the guidelines for live CME include an imperative to provide participant feedback, which may lead to further outcomes data.

Dr. Borman expects that the new criteria will be considered and hopefully adopted by partner organizations, that is, specialty accreditation boards.

"Outcomes evaluation is still a fairly unknown area in Europe, with a great opportunity for providing guidance," commented Dr. Thomas Kellner, managing partner of AxDev Europe, after participating in the recent European CME Forum in Amsterdam. The topic was addressed by several speakers, among them:

Dr. Helmut Madersbacher, who described the pre and post-assessment used byEuropean Society of Urology to measure knowledge gain and retention

Prof. Miklós Udvardy, who discussed the approach of the European Hematology Assn. to identify gaps in care and remedy these through online and live CME

At ECF, the Good CME Practice group (gCMEp) presented a set of 4 core principles, one of which speaks to outcomes measures:

Educational activities should have clear learning objectives derived from a process that has identified performance gaps and unmet educational needs

Balance needs to be evident in content, faculty and review, developed independent of sponsor

All relevant information, including terms of financial support, should be disclosed to the learner

In Australia, all practicing physicians must participate in a range of CPD activities meeting standards set by their college, says the Medical Board of Australia. These include practice-based reflective elements, such as clinical audit, peer review or performance appraisal as well as knowledge improvement.

The Royal Australian College of General Practitioners (RACGP) has recently adopted a CPD course, GP Update, based on a "successful British model" -- a series of workshops exploring practical ways to apply current evidence to patient care. Content of the workshops is evidence based as well as relevant to Australian general practice, says RACGP president Prof. Claire Jackson.

1 The Physician Consortium for Performance Improvement (PCPI), convened by the American Medical Assn., has adopted new standards for assessing outcomes. They must be clinically relevant, meaningful, measurable and actionable by the clinician, says PCPI. Measures developed by PCPI are used by the government's Physician Quality Reporting System, which becomes mandatory in 2015.

2 In Italy, the satellite SKY channel 440, dedicated to doctors, has started broadcasting 24 hours a day with news, live presentations from operating theaters and free CME -- a first from a TV platform in Europe. The Italian health minister has welcomed this new initiative.

3 Industry would like to be supporting performance and patient outcomes initiatives in CME, says Dr. Hilary Schmidt of Sanofi-Aventis, in clarifying the report from GAME in the last issue of this newsletter. But the large majority of grant requests are still at the lower levels of satisfaction and knowledge change. This is borne out in results of a survey of commercial supporters reported at the recent meeting of the National Task Force on CME Provider/Industry Collaboration.

4 Correcting another GAME report in the last issue of the newsletter, Dr. Thomas Kellner notes that in Germany, pharmaceutical companies can provide CME in Germany, and there are no plans to change that.

Notice our new logo?
We have changed our name to reflect a broader scope: Serving
organizations seeking expansion and recognition of their international
continuing health education activities.By early 2011, we will be
offering not only consulting but also implementation and information
services scaled to meet your specific needs, utilizing our worldwide
experience, insights and associates. Watch for more!

"What
is the value proposition of your CME programs?" That was the question
posed to participants in the June 2011 annual meeting of the Global
Alliance for Medical Education (GAME) in Munich by Don Moore PhD of
Vanderbilt University USA, one of the preeminent thinkers in CME today.
He was followed by Hilary Schmidt PhD of sanofi, who asked: "What is the
value of CME to industry?"

Moore's answer:

Value in health care is measured in terms of outcomes

Value in CME must also be measured in terms of outcomes

Outcomes for CME should be related to outcomes for health care

Schmidt's answer:

Industry support should relate therapeutic focus to healthcare quality gaps

CME should meet needs of healthcare providers and patients

Most companies in US now require measures of CME outcomes

These measures now include knowledge and often competence

There's
a gap between Moore's emphasis on performance and healthcare
improvement outcomes and industry's emphasis on knowledge outcomes and
to some extent competence. Is it reasonable to ask CME providers to
measure value in terms of change in healthcare outcomes? Or are there
too many intervening factors? Where is your organization on this scale?
(Slides of both talks are available to GAME members. Click here.)

Collaboration
was a major theme of the 2011 GAME meeting, but as 2 speakers pointed
out, in Europe collaboration requires first understanding the
differences in national CME systems. Madeleine Schaffer (r) of EIMSED,
Vienna, and Ina Weisshardt (l)MD of White Cube, Munich, described the
issues they encountered across 10 countries seeking to find the best
approach to CME for family physicians. Here are some of their findings:

Physicians in some countries are licensed immediately after graduation; others only after completing specialty training

Medical schools play a central role in CME in Ukraine and Hungary; almost no role in Austria, Germany, Italy

Credit systems are similar, though not identical

Mandatory CME without teeth in many countries; voluntary with teeth in Ukraine!

Accreditation can mean providers, programs, recognition of physicians

GPs are doorkeepers in Italy, UK, Spain; not required in Germany, France, Austria

Conclusion:
It's not easy to be a one-stop CME center in Europe. Providers need to
understand and adjust for the differences if education is contribute
value to the learner and to patients.
(Slides of their presentation are available to GAME members. Click here.)

Collaboration
does seem to go more easily in the US, as George Mejicano MD from
University of Wisconsin, Suzanne Murray of AxDev, Montreal, and others
pointed out in describing a major collaborative campaign to reduce
smoking, supported by Pfizer. Use of national, regional and local
resources is making a difference, they said.

A
Centre for Continuing Professional Development (CPD) is building up
steam in Khartoum, Sudan, reports Alfonso Negri MD, a WentzMiller
associate who independently served as a consultant to the WHO Office in
Khartoum.
WHO is assisting the Federal Ministry of Health in establishing the
centre and a system for relicensing based on CPD credit hours.

Up
to now, the centre has organized short courses for about 6000 health
professionals, and has set up 6 regional CPD centers to focus on
training for TB, HIV and malaria. The goal is to develop health
professionals capable of delivering high quality services in a changing
environment and committed to a culture of learning.

36
years after its founding as a way to bring together diverse groups with
an interest in CME, the Alliance for CME is broadening its based to
become the Alliance for Continuing Education in the Health Professions
(ACEHP), following the lead of the Journal of that name. George
Mejicano, MD, president, said the membership would vote on the new
direction in October, according to an interview in Medical Meetings online.

The
Alliance is reaching out to education professionals in nursing,
pharmacy and physician assistants, Mejicano said, and will serve people
involved in promotional as well as certified CME. Plans are afoot to
create an Alliance research institute as well, he reported, and there
may be a "functional sector" for those interested in global education.

1
In our last issue, we quoted Anna Frick of AstraZeneca as saying that
AZ would no longer sponsor delegates to congresses. We noted that she
was outgoing president of the International Pharmaceutical Congress
Advisory Assn. (IPCAA). Sylvia Fondaneche (l), current president, wants
to make clear that IPCAA has taken no position on the matter,and that
Ms. Frick was speaking only for AZ.

2
Dr. Dennis Wentz was impressed that the recent Vienna meeting of the
Assn. of Medical Education in Europe highlighted CME/CPD much more than
in the past. "Medical higher education is a global industry," said Dr.
David Wilkinson, dean of medicine at University of Queensland,
Australia. "International education is one of Australia's growing
industries."

3 For the first time since 2006, total certified CME income in the US, according to the Accreditation Council for CME,
increased in 2010, by 2.7% to $2.42 billion. From 2007-2010, income
dropped by 11.7%. In 2007, commercial support accounted for 51% of the
total -- but in 2010 only 37%, a decline of almost $300 million.
Participant registration and support from parent organizations rose by
20.7% over the same period. Interestingly, the number of activities
supported declined while total physician and nonphysician participation
rose steadily from year to year. More detail is available in an ACCME addendum.

4
The popular British website, doctors.net.uk, organized by physicians to
provide physicians with up-to-date information and education, has been
acquired by M3USA, an international online healthcare company, reports PMLive. Doctors.net.uk is used by more than 40,000 doctors every day.

Coverage
of the annual meeting of the Global Alliance for Medical Education,
June 5-7, in Munich, is delayed until presentations are posted on the
GAME website. Exception: A report of Hans Karle's acceptance of the
Hippocrates Award. See below.

Medical
congresses and pharma support? "We have been thriving on an old
business model, nurtured by the pharma industry and a model tolerated by
government," said Stefan Schneeberger, an Austrian transplant surgeon.
He was speaking at a recent IMEX meeting in Frankfurt, Germany, to a group that represents exhibition, events and travel industries.

Schneeberger
called for open discussion among medical congress organizers,
physicians and the pharmaceutical industry, particularly to deal with
the issue of payment for doctors to attend congresses. "It remains
ethically challenging," he said. A response came from Anna Frick, head
of the AstraZeneca (AZ) global conference department, who announced that
AZ would no longer sponsor delegates to congresses, but instead would
focus on educational grants to societies that would benefit patient
care. "There will be more competition for less funding," she said.

Frick's
comments carry extra weight as she is outgoing president of the
International Pharmaceutical Congress Advisory Assn. (IPCAA). What's
more, AZ CEO David Brennan said the company "should not do anything that
could be seen as an inducement to prescribers to use its products."
Added Richard Bergstrom, head of the European Federation of
Pharmaceutical Industries and Assns. (EFPIA), this is "another sign that
industry is changing its scientific educational practices."

The news service Reuters
points out that "scrutiny has been ramped up with a wave of
investigations under the US Foreign Corrupt Practices Act (FCPA) and the
new bribery act in Britain." The latter focuses on commercial bribery
as well as bribery of foreign public officials.

Meanwhile, India's Department of Pharmaceuticals has proposed a voluntary code
banning gifts to prescribers. The exception: Monetary assistance to
doctors for actual travel, hotel and registration expenses for attending
CME events organized and held in India -- but not in conjunction with
sporting or entertainment events. There's already been an objection to
the latter: Why shouldn't doctors attend meetings held at the same time
as a cricket match? asked one blogger.

It
appears that the percentage of pharma funding for a CME activity in the
US increases physician perception of bias, according to a study
recently published in Archives of Internal Medicine. The authors
surveyed clinicians attending 5 live HIV CME events. While 86% of
respondents saw bias in events funded 100% by commercial support, only
46% felt the same if the funding was only 20% of the total.

Bias
or not, 56% of respondents said commercial support is essential for
CME; only 42% were willing to pay higher registration fees. Most vastly
underestimated the costs of putting on a CME program.

To
deal with the "taint", the American Gastroenterological Assn. (AGA)
rolled out an old idea: Give grants to our education fund and we will
decide how to use the money. Pharma listeners at a Support for Independent Medical Education Conference had the same old cool response. 10 said the idea was great but unrealistic, 3 said "Are you nuts?".

PS: Despite the controversies, and past declines in pharma funding of CME, there was a ray of hope in data from research firm cedigim:
US pharma spending on professional meetings and CME rose about 8% in
2011 first quarter compared to 2010. But the big increase came in dinner
meetings; CME was up slightly and conference spending down. These data
were contained in an email not posted on the cegedim site.

"I
am not in favor of attempts to force rigid programs for all doctors,"
said Dr. Hans Karle, former head of the World Federation for Medical
Education (WFME), on receiving the Hippocrates Award at the recent
meeting of the Global Alliance for Medical Education (GAME) in Munich.
"CPD must be individualized."

Reviewing
the white paper on CME/CPD issued by WFME in 2003 to encourage medical
schools around the globe to participate in lifelong learning, Dr. Karle
spelled out several principles that are not often observed in CME
systems today:

CPD must be tailored to the needs of the individual doctor, based on needs assessment

CPD should emphasize self-directed and active learning

Medical schools must provide leadership in improving CPD quality

CPD must be recognized as an integral part of medical practice reflected in resource allocation and time planning

Funding of CPD must be part of the expenses of the healthcare system

These
standards, he said, have served as a benchmark in development of
national standards in China, Ecuador, Egypt, France, Georgia, India,
Iran, Russia and Ukraine.
The Hippocrates Award honors individuals who have made substantial
contribution to global CME over a period of years.

China
has structured a mandatory CME system working from the Health Ministry
to provincial Bureaus of Health to regional Boards of Health, Zeng
Zhechun MD of the Beijing Assn. of Medical Education reported at a
recent meeting of the US Society for Academic CME (SACME). But the
system has its challenges:

An imbalance in CME courses from the major urban provinces to the rural provinces

Doctors
must get 25 credits a year: 5-10 from attending state or provincial
level courses, live or distance; 15-20 from self-study, scientific
publications, organizing or presenting academic activities. Distance
learning is limited to <10 credits. Providers must submit
applications for review by provincial and then state CME committees.

In
the future, Dr. Zeng projects more government investment and improved
quality, based on needs assessment of practices, patient-centered
training, and application of educational theories and outcomes research.

1
The CME book of the decade is now available! Pardon our enthusiasm, but
we are proud of "Continuing Medical Education: Looking Back, Planning
Ahead," a 400-page volume edited by Dennis K. Wentz MD, with chapters by
some 75 present and former leaders in CME worldwide. If you are
interested not only in the history but also the future of CME around the
globe, this is a book worth reading and keeping. Copies can be ordered
from Dartmouth University Press at a 30% discount by entering the code DM 124, especially for readers of this newsletter.

2
More and more CME providers in Europe are moving to accredit online
courses through the European Accreditation Council for CME (EACCME). Its
parent body, the European Union of Medical Specialists (UEMS) has
recently issued updated requirements
for accrediting "e-learning materials," which also include recorded
audio and visual discs. An appendix notes that EACCME is exploring
potential for provider accreditation; it is now only program
accreditation.

3
Healthcare professionals (HCP) around the world are increasing their
use of social media -- sometimes for CME. The first international event
entirely dedicated to social media and health-care in Europe took place
on June 22 & 23 in Paris, titled Doctors 2.0,
and brought together delegates from medical associations and pharma
companies. Physicians in the emerging BRIC (Brazil, Russia, India and
China), particularly in Russia and India, are incorporating social
networks and online communities into their professional resources,
according to a study by Manhattan Research. And in the US, a survey by UBM Medica US found that 37% of HCPs engage in social media for personal and professional purposes.

4 The European CME Forum has announced the launch of its new Journal of European CME, an open access, peer review online journal edited by Prof. Robin Stevenson, a well-known authority on new directions in accredited CME. Submissions welcome. The next forum will be in Amsterdam, 10-11 November 2011.

Don't
miss the annual meeting of the Global Alliance for Medical Education,
June 5-7, in Munich. There is an exciting lineup of speakers, a great
venue and an excellent opportunity to network with colleagues from
around the world. Don't wait to register. Go to GAME 2011.

The
World Health Organization (WHO) has given the global CME community a
challenge: Help save millions of lives by reducing risk factors, early
detection and timely treatment of noncommunicable diseases (NCD),
principally

Cardiovascular diseases

Diabetes

Cancers

Chronic respiratory diseases

This is a major shift for WHO, which in the past has emphasized reduction in rates of infectious diseases. A recently released Global status report on noncommunicable diseases
projected continuing increases in NCD deaths, with the greatest rise in
low and middle-income regions. Many of these countries are still
struggling to reduce maternal and child deaths caused by infectious
diseases, says WHO.

To make clear the mandate for change, WHO notes that low and middle-income countries report:

>80% of cardiovascular and diabetes deaths

90% of chronic obstructive pulmonary disease deaths

29% of deaths among people under 60%

When
CME providers seek to help reduce the number of deaths and/or serious
morbidities, where should they start? WHO recommends addressing 4 main
behavioral risk factors:

Tobacco use

Physical inactivity

Harmful use of alcohol

Unhealthy diet

While
the WHO report emphasizes the value of national programs of tax
increases on tobacco and alcohol and promoting public awareness, the
organization also sees benefit in individual intervention with patients
to initiate preventive care and early detection. CME, especially if
coupled with patient education, has the opportunity to make a
difference. Funding: That is a major issue. Your thoughts?

A recent survey
conducted for the Pharmaceutical Research and Manufacturers Assn.
(PhRMA) found that US physicians ranked continuing medical education
(CME) courses tops among sources for keeping up to date on medications
to treat their patients.

PhRMA,
of course, was interested in the perception of the doctors surveyed --
42% primary care, 58% specialists -- about the pharmaceutical company
role in help them stay informed. Here is how the sources ranked, as very
useful:

61% CME courses

52% Articles in peer-reviewed journals

47% Clinical practice guidelines

46% Colleagues and peers

38% Web-based sources, e.g., Medscape, Web MD, FDA-CDER

33% Handheld internet databases, e.g., Epocrates, Lexi Comp

28% Pharma-sponsored education, non-CME

27% Subscription based sources, e.g., MicroMedex, Lippincott's

26% Pharma companies and their representatives

When
deciding what to prescribe for an individual patient, respondents by
far make their decisions based on their clinical knowledge and
experience, and the patient's response to a particular medication.
Educational and pharma information resources play a very small role --
the exception being clinical practice guidelines. Is the gap because
physicians don't always recognize what influences their clinical
knowledge?

Doctors.net.uk, a leading provider of CME and medical news to UK physicians, is expanding around the world through Networks in Health,
an international alliance of online physician communities. In the UK,
doctors.net.uk has more than 180,000 registrants. Its initial group of
affiliates more than doubles that number.

Doctors.net,uk
was created for doctors, by doctors in 1998. Some 600 doctors now act
as advisers and clinical information contributors. Some 30,000 doctors
access the site's 230 accredited CME programs every month. The new
alliance will allow members of those communities to access this
educational content, and offers pharma companies a chance to conduct
research studies.

The authors identify 2 problems hampering the spread of e-learning in Italy and Europe:

Gaining accreditation for the activity

Confusing e-learning with delivery of documents and questions through the internet

With
funding from the Italian Ministry of Health, an e-learning system was
devised for free use by Italian physicians and other health
professionals. The site
now offers 5 courses built around some basic principles of e-learning.
The article describes a patient handling course primarily for nurses, in
which 7,811 users enrolled. Dropouts were 12.5% early on, but then
almost 80% successfully completed the 5-hour accredited program over
time.

Amazingly,
the course design was complex. It began with a mandatory test, went
through self-learning modules, case-study exercises to reinforce the
learning process, and a final test. Participants had to score 75% on the
case studies and final exam to gain credit (with 4 attempts allowed).
The failure rate was very low, leading the authors to conclude that the
program was a success -- in knowledge acquisition.

1
Immigrant physicians -- mostly from the former Soviet Union -- working
for Israeli Defense Force primary care clinics needed training to meet
patient care requirements. A 3-year CME program was devised and outcomes
measured. In a JCEHP article, the authors reported encouraging results that might be replicated in other countries.

2
The International Continuing Health Education Collaborative, based at
the University of Toronto, has had a busy year to date, reports Abi
Sriharan. It delivered a joint 1-year training program in clinical
audiology in Qatar and organized a program for leaders of China's
Ministry of Health and FDA in Canada to learn about advances in medical
device management and regulations. A related group has developed a joint
program to strengthen nursing capacity in Canada and Israel.

3
A recent poll by a British organization found that 88% of healthcare
exhibitors surveyed say the exhibits of the future will be focused on
clinical discussion rather than promotion and sales. The industry is
being challenged to provide healthcare professionals with more than they
can get at home, in the face of declining budgets.

Need Help?

WentzMiller
& Associates is ready to help your organization with strategic
planning services. We have consulted with pharmaceutical companies,
medical education companies and medical specialty societies regarding
their plans for international activities. We welcome your inquiries.
Contact lew@wentzmiller.org or dkwentz@aol.com. OR SEE US AT GAME!

The
world's upheavals in Japan, Libya and elsewhere make our CME corner of
the world seem insignificant at times. Nonetheless, we can make the most
of opportunities to make a difference in who and how we educate. What
really is our mission? See below -- and comment, please, to
lew@wentzmiller.org.

"In
Singapore, they call it CPD, while the rest of Asia still says CME,"
reported Lisa Sullivan of In Vivo Communications at the recent Alliance
for CME meeting in San Francisco. Dr. Bernard Maillet, secretary general
of UEMS-EACCME, continually referred to CME-CPD in Europe at the same
meeting. And the Alliance for CME announced a need for a name change to
fit its new strategic vision:

"The
Alliance is a recognized leader and trusted partner that exists to
close gaps in healthcare performance by translating the best science and
knowledge into effective continuing professional development."

Clearly,
the leadership of the Alliance is pushing us to play a bigger role in
the healthcare world. Their decision was "to expand the focus of the
Alliance beyond certified CME and to broaden its focus to include
healthcare-related continuing education and continuing professional
development." The emphases are on interprofessional education and
improving health outcomes.

At
its annual meeting, the Alliance also announced the launch of an
ambitious program to train CME workers to be more than CME
professionals. CALLS (Competency Assessment and Lifelong Learning
Series) is designed to:

improve proficiency in CME

prepare people for the Certified CME Professional Exam

teach best practices in assessment and evaluation

support proper physician self-assessment fort learning and change

address barriers to the improvement of healthcare

What
has been the reaction of the US CME community? In response to the new
vision, there has been some skepticism that the Alliance Board is
overreaching, as well as confusion about what this expanded role means.
Most providers still focus on what they must do to maintain
accreditation in the face of increasingly tough demands from the
Accreditation Council for CME (ACCME). Will ACCME change its mission as
well? It has been in conversation with accrediting bodies of other
health professionals, so there will be more to come. It is too early to
predict reactions from around the world.

The National Institute for Health and Clinical Excellence (NICE) has announced a new program
to help GPs in the UK keep up to date with current recommendations on
clinical practice, public health and social care. The site contains
links to the 10 most commonly used guidelines:

Says
London GP Dr Liam Smeeth, a member of the Guideline Development Group:
"The NICE chest pain guideline will help ensure people get the treatment
they need when they need it. It outlines a very simple test, called
calcium scoring, that GPs could do to assess heart disease risk. We know
that if there is no calcium in the arteries, then you can confidently
say that that patient does not have heart disease."

The
site also offers resources to help find timely and up to date advice
for patients, with links to services to support decision making at the
point of care. In addition, by registering with My Evidence, users can
tell National Health Service (NHS) Evidence what their particular areas
of interests are and receive regular updates about new information in
those areas.

"Urbanization,
an aging population and changing disease patterns are triggering heath
concerns in areas such as diabetes, cancer, infectious diseases, and
asthma," says PharmaVOICE.
Quoting IMS Asia Pacific, the article notes that China has the largest
diabetic population in the world, growing at 16% a year,

China
now has the start of a CME system, and growing interest in expanding
its reach, particularly because of the healthcare reform started in 2005
that is extending health insurance coverage to millions of citizens and
is retraining many frontline doctors to become family doctors in small
city clinics. Western pharmaceutical companies are rapidly building
their presence in the country, and offer opportunities to support CME.

Yes,
says the Alliance for CME in the US, which includes advocacy as one of
its new goals in strategic planning. Yes, says a group of medical
education companies led by Thomas Sullivan, who conducts a regular blog
on Policy and Medicine.

Sullivan
made a presentation at the recent Alliance for CME meeting in San
Francisco, promoting the idea of forming a CME Consortium that would
hire a Washington DC lobbying firm to defend the concept of commercially
supported CME. It is not clear whether the idea will fly, since it does
not have the formal support of the pharmaceutical industry nor of CME
providers such as medical schools, who seem to be pulling away from
commercial support whenever they can.

The latter trend is highlighted in the report of the 2010 Harrison Survey of
US and Canadian medical schools. There is "a clear movement away from
commercial support for academic CME and one more supported by
registration fees and institutional support," says the report. It also
noted a decline in the number of live and online learning activities and
a modest increase in academic detailing and performance improvement
activities.

2
Coming soon, Dr. Dennis Wentz' landmark book titled "Continuing Medical
Education: Looking Back, Looking Ahead," covering all the significant
developments in CME around the world. Release date is June 2011 through
Dartmouth College Press of University Press of New England.

3
France is in a turmoil, reports WentzMiller associate Dr. Herve
Maisonneuve. "We have a huge drug scandal, politicians are accused of
protecting Servier (which withdrew benefluorex after it apparently
caused between 500-100 deaths) and all the pharmaceutical industry," he
said. The fallout can harm the future of CME; the government is
considering a tax on industry to fund CME. France still has no CME
system in place.

4
The new CME provider system in Italy is in full implementation,
according to Dr. Alfonso Negri, a WentzMIller associate. "The number of
providers has been greatly reduced from 12,000 to 300, with stricter
regulations and controls." We await an evaluation of results of this
change.

Need Help?

WentzMiller
& Associates is ready to help your organization with strategic
planning services. We have consulted with pharmaceutical companies,
medical education companies and medical specialty societies regarding
their plans for international activities. We welcome your inquiries.
Contact lew@wentzmiller.org or dkwentz@aol.com.

The question of whether continuing medical education is primarily a national activity is governed by accreditation systems in many countries around the world, especially when CME is mandatory by government or specialty society fiat. Within a given country, such as the US, the UK, Italy, Australia or Canada, accreditation systems are national. But within a country, there may be more than one system of accreditation, depending on the specialty of the physician or where he/she works (office practice, hospital, government agency).

More and more, however, we are hearing the challenge: CME is global, or at least regional. Dr. Thomas Kellner, who has been leader global medical education at MSD, wrote recently in PMLiVE: "The spread of disease is global. Pathophysiology is global. Many educational needs are similar around the world. If variations in national accreditation requirements are assessed at the outset, they will not be barriers."

But will they truly vanish? Yes, harmonization is a goal of many CME organizations, including the Global Alliance for Medical Education (GAME), the Rome Group, the Good CME Practice Group (gCMEp), and more. But in practical terms, it is difficult to accomplish. Here are some current barriers to consider:

A program accredited for US family physicians is not acceptable in Canada because the rules of the College of Family Physicians there call for 5 Canadian family doctors to be on the planning committee

"There are significant disparities among EU countries on the types of CME activities that are valid to collect CME credits," says an article in European Journal of Cancer

While the European Accreditation Council for CME (EACCME) has reciprocity with the US AMA for credits, this applies only to certain types of programs

The EACCME accredits international programs, but some National Accreditation Authorities (NAA) have not yet signed an agreement to automatically recognize these credits

There are several European specialty accreditation boards, each of which prefers to grant its own credits and may or may not recognize credits granted by EACCME or a NAA -- or vice versa

Contrast this with the recent European Parliament Cross-border Health Care Directive, which will allow EU residents to seek healthcare treatment in any of the 27 member states, from 2013. Why should CME be treated differently? If CME were completely voluntary, or, as in the UK, linked to an individual's plan for improvement regardless of accreditation, the problem would be greatly diminished. Unfortunately, the bureaucratic battles that exist in North America and Europe are likely to be carried out elsewhere as mandatory CME grows.

At the same time, all of us in the CME field recognize the growth of e-learning as a means to spread valuable knowledge to physicians around the world. More providers of quality education, whether specialty societies, academic medical centers or medical education companies, are seeking to extend the reach and value of their content globally. The Question for 2011 is this:How can we accomplish this lofty goal within the constraints of mandatory bureaucratic systems? Let us know your answer!

Not much, according to a recent report. Researchers analyzed 53 reviews of electronic health systems and found only limited evidence to support large investments in electronic health records (EHR) computerized order systems and other health information technology (IT) tools. The report in PLoS Medicine, states:

"There is considerable international interest in exploiting the potential of digital health care solutions, often referred to as eHealth -- the use of information and communication technologies-to enhance the quality and safety of health care. ... Any large-scale expenditure on eHealth -- such as electronic health records, picture archiving and communication systems, eprescribing, associated computerized provider order entry systems, and computerized decision support systems -- has tended to be justified on the grounds that these are efficient and cost-effective means for improving health care. ... England has invested at least £12.8 billion in a National Programme for Information Technology for the National Health Service, and the Obama administration in the United States has committed to a US$38 billion eHealth investment in health care."

The researchers continued: "There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and "techno-enthusiasts" as if this was a given."

Were there any benefits found? Yes. Electronic prescribing systems did reduce errors in medication orders. And the most significant achievements did occur in hospitals and large health care organizations that specifically customized technology to maximize performance. Overall, a disappointing finding, especially for CME providers looking to link their efforts to improve performance to the use of EHR.

In two highly different but small nations of the world, researchers sought to determine barriers to learning through CME. These were quite different in the UAE versus Barbados, perhaps depending in part on the economic climate of both countries.

In the UAE report, physicians and nurses agreed on the importance of CME to the development of their profession, even though a majority of health care workers are expatriates. The barriers to participating varied. GPs in smaller organizations felt that the CME sessions were not targeting their needs. Nurses lacked transportation to CME meetings, and complained about the cost. Finally, 31% said they would not take CME if it was not necessary for their licenses. (It is mandatory.)

In Barbados, the authors studied the attitudes of primary care physicians to guidelines regarding care of diabetes and hypertension. "Most private physicians had read the guidelines but did not follow them because they were outdated, not patient centered, difficult to remember, and did not give advice on how to tackle barriers," the report noted. Patient denial of their illnesses and system problems -- lack of resources and medications -- made it even more difficult to provide good care.

1 Alfonso Negri MD of Italy, a WM&A associate, and Bernard Maillet MD, head of EACCME/UEMS, were impressed in a December visit with the progress of CME in Albania after 2 years. 7,363 doctors are participating in a program that requires recertification every 5 years. The Swiss Cooperation Agency is assisting in restructuring the health system.

2 After some doctors complained about a course for medical students on pain management, in which a company provided the guest lecturer, the University of Toronto said a perception of conflict of interest did exist. A revised course should be in place by spring, taught only by faculty members -- with no financing from drug makers.

3 The Global Alliance for Medical Education (GAME), the primary organization of international leaders in CME, will hold its annual meeting June 5-7, 2011, in Munich Germany. The theme will be collaboration in CME. More information is available at http://www.game2011.org/.

4 Comments from readers:

Bernard Maillet MD, head of UEMS/EACCME, challenged a statement in the last issue by Thomas Kellner MD regarding planned changes to CME to accredit providers. "We NEVER considered to accredit providers," he says.

Suggests Matt Lewis of the US: "It might be useful to see what the CME/promotional med ed requirements are in each EU country." Anyone have that information?

Michael Farley of Canada writes: " Congratulations on your informative newsletter. Progress in CME becomes more important than ever for 'fusing' cooperative activities among the professions and industry."

WentzMiller & Associates is pleased to announce that Gregory Paulos MS MBA of Peoria AZ has joined as an Associate. Greg most recently has been CEO of GenLife Institute, a whole body donation and medical education organization. Previously, he had been professional education officer at the American Society for Gastrointestinal Endoscopy and associate director of the AMA's division of CCPD.

WentzMiller & Associates is ready to help your organization with strategic planning services. We have consulted with pharmaceutical companies, medical education companies and medical specialty societies regarding their plans for international activities. We welcome your inquiries. Contact lew@wentzmiller.org or dkwentz@aol.com.

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